Author: Research

Spanish ME/CFS with Fibromyalgia

Back Story

In 1994, after two years of a high stress job managing and motivating direct sales groups in my own sales company I quit and I spent 6 months very fatigued, without moving my body very much and staring at the void sitting on my sofa. I could barely lift a glass of water. After the six months I regained strength and I commenced in a new job. Doctor said I had the yuppie flu, gave some vitamins and tests showed I had had epstein-barr viruses.

In 2008 I recall being very fatigued again. And again 6 months secluded at home sleeping 14 hours a day (I have no family in Spain). I could work but I was uneasy and the job was stressful at times,. In 2009 I started to undergo tests in a private clinic, cause the public hospital who was cutting edge at CFS has a a waiting list of years. I wanted to know what I had. Blood samples, screening, mutaflor, some other immune system boosters, etc. Diagnosis 2010: CFS (not Fibromyalgia yet). I started also to attend to conferences and read a lot about my illness (which I don’t do anymore).

In 2016, after years working with fatigue and pain I decided I couldn’t stand it anymore and thought I should care about myself so I went on sick leave for one year. Afterwards I solicited voluntarily leave of absence.

CFS/EM slowly shifted more to Fibromyalgia. I was diagnosed in one of the best public Hospitals in Barcelona (the renowned Hospital Clínic). They gave me advice on doing exercise, not much more.

Now I say I have moderate EM and moderate to severe Fibromyalgia. Depends on the day. I stay at home mainly. IBS, Psoriasis, Costocondritis sometimes, eye problems, dizziness. muscular problems and stiffness, etc. I am going to a Quiropractic for many years. With an electric bike I can do some miles.

I see there are a lot of supplements in Biomesight, It would be highly appreciated if you could give some insight of my Biomesight results and how to get started changing my gut’s microbiome (food, supplements, etc).

Clarity on Suggestions from Biomesight

I do not know how Biomesight derive their suggested supplements. Many microbiome providers use nutritionists who often suggest generic “healthy” supplements. In other cases, they have found a study for a supplement that impacts one bacteria and if you are high or low for that bacteria, suggest that (ignoring what that same supplement will do to other bacteria!). I would love to see a detailed blog from Biomesight on how they determine appropriate supplements to suggest.

Microbiome Prescription uses almost 1.9 million facts(i.e. X substance modify Y bacteria) and then consider all interactions that a supplement has on all bacteria of concern.

Analysis

First, we will look for a common fingerprint for ME/CFS and Long COVID: Over representation of bacteria in the 0-9%ile. We have a very strong match shown below. The numbers in each range should be about the same number for a healthy microbiome.

Looking at Dr. Jason Hawrelak Recommendations we find it at 75.3%ile, indicating issues with the following being most concerning:

  • Bacteroides at double his high limit
  • Faecalibacterium prausnitzii well below his low limit. This bacteria is deemed anti-inflammatory [2008] and thus a contributor

The Potential Medical Conditions Detected using the US Library of Medicine studies show what you reported and a few other items of concern (Asthma, Colorectal Cancer [possible false positive], etc)

  • Fibromyalgia 96%ile
  • Chronic Fatigue Syndrome 96%ile
  • Inflammatory Bowel Disease 94%ile
  • Gastroesophageal reflux disease (Gerd) including Barrett’s esophagus – 97%ile

Going Forward

First a quick video on the process

I did the “Just give me suggestions” followed by individual sets of suggestions for the four above item resulting in 8 sets of suggestions done with different criteria to select critical bacteria (See video). We then use consensus to identify the items most likely to help. This is a way to improve results in the face of many unknowns.

There are a lot more items, but the above should be a good start. Now the items to reduce or cut (if taking):

Postscript – and Reminder

I am not a licensed medical professional and there are strict laws where I live about “appearing to practice medicine”.  I am safe when it is “academic models” and I keep to the language of science, especially statistics. I am not safe when the explanations have possible overtones of advising a patient instead of presenting data to be evaluated by a medical professional before implementing.

I cannot tell people what they should take or not take. I can inform people items that have better odds of improving their microbiome as a results on numeric calculations. I am a trained experienced statistician with appropriate degrees and professional memberships. All suggestions should be reviewed by your medical professional before starting.

The answers above describe my logic and thinking and is not intended to give advice to this person or any one. Always review with your knowledgeable medical professional.

Repeat IBS + Vaccine + COVID

This is a follow up to the January 2022 post, IBS + BioNTech COVID Vaccine -> ME/CFS? For discussion on vaccination changing the microbiome see that post (ANY thing that changes the microbiome has a risk of cascading into ME/CFS — an innocent kiss could result in result in the kissing disease( Infectious mononucleosis) which is usually Epstein-Barr virus and well associated with ME/CFS!).

[Revised: Jul 27th,2023 There was a mix up on the sample for some analysis]

The Request

One biomesight test failed and then I got Covid again, so I had to wait.

There are some improvements since last time: I can listen to music again. I can play cards with my brother a little bit in the night when it’s quiet. I was also able to breathe freely again while doing most things, but in January I had an exhausting doctors appointment and some improvements were lost.

A few specific questions:

  •  Are the “mold bacteria” you mentioned last time still a problem?
  • Have there been any important/significant new treatments or scientific findings recently that you are aware of that would help me with my issue (CFS from biontech vaccination)?

Things I am taking continuously right now: Magnesium malate, Coenzyme Q10, Acetyl-L-carnitine, Vit. D+K2, Piracetam.

Analysis

“In one study researchers were able to classify 83% of the ME/CFS patients correctly based on their dysbiosis in gut and increased inflammatory markers in blood as a consequence of microbial translocation” 

Reduced Diversity and Altered Composition of the Gut Microbiome in Individuals With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Microbiome [2016]

We have three samples, the first one was at the start (and used in the above post). I mentioned in the earlier post that he had not had the symptoms long enough to be deemed ME/CFS. The table below seems to show that the typical ME/CFS and Long COVID pattern is not an immediate result but is cascaded into over time. The pattern of over representation of the percentage in the 0-9 percentile showed up in subsequent samples. We see agreement with his subjective opinion of improvement and then loss of progress in the numbers below.

Nov 2021Nov 2021May 2022May 2022Jun 2023Jun 2023
PercentileGenusSpeciesGenusSpeciesGenusSpecies
0 – 9111056814354
10-19121615141316
20 – 29121315211711
30 – 3916191211818
40 – 499132117913
50 – 59192415261414
60 – 69131915171719
70 – 79232012211111
80 – 89141814161212
90 – 991212912514
Shannon Diversity Index79%ile83%ile42%ile
Jason Hawrelak96%ile95%ile56%ile
COVID %ile83%ile71%ile83%ile

The “mold bacteria” is a reference to Prevotella. This often grows excessively when there is mold or fungi. His latest sample had a low percentile, so unlikely to be an issue. 

Going Forward

Doing “Just Give Me Suggestions” executes the following four individual approaches:

On the simplified summary (intended for those with severe cognitive impairment) there is a button that takes you to the full details (the consensus report)

This gives a list of 1800+ different items that were evaluated. I am not a medical professional and do not have clinical experience. My choices from this tend to arbitrary but with the following guidance:

  • To take items should be at least 50% of the highest value (in this case, 553 /2 =277)
  • To Avoid items should be below 50% of the lowest value (in this case, -541/2 = – 270)
  • If the person has ME/CFS or Long COVID, and I know from reading the literature that studies found that it helps people, I will tend to pick those items
  • In general, I will not suggest prescription items because most patients will be stonewalled by their MDs on doing prescription items off label. If I do (because the patient reported having a cooperative MD), I will tend to keep to items documented to help ME/CFS patients.

I then checked what is he taking against the results:

So handpicking from the suggestions (with value):

Because the reader is in the “Land of Mutaflor” (Germany), I checked that explicitly in two ways:

  • Using KEGG Data — it was the top probiotic (but the value was lower than usual)
  • Using Consensus Data — it was very slightly positive (0.3).

So it does no apparent harm (except on pocket book), and I would consider trying it after the above bifidobacterium because low E.Coli has been reported in studies (16s does not provide data).

Checking KEGG suggested supplements against the consensus, we have the following in agreement:

  • Arginine, Consensus:40
  • Leucine, Consensus: 85
  • Vitamin B1 Thiamine, Consensus: 201
  • Vitamin B2(Riboflavin), Consensus: 32
  • Vitamin B7 biotin, Consensus: 184
  • Glutamine, Consensus: 158
  • Histidine, Consensus: 31

Remember we are dealing “fuzzy data on sparse data” and use the consensus approach to improve odds of picking things that will actually do positive changes. By comparing KEGG identification of metabolites that appear to be at low level (and thus starving some bacteria) with the same items that will improve the bacteria balance, we add another layer to consensus building for suggestions. One more layer is taking substances shown to help ME/CFS which are not in our database. He appears to be making use of my CfsRemission site for that purpose. Consensus and layered is the most likely to produce good results.

Antibiotics

This person reports a friendly medical professional. So:

I would do the first one only. I have a pending post with a video with Cecile Jadin which may be helpful.

To Avoid

This is usually selecting items that are likely to be taken by some. If it is below -270, it should be consider to reduce of eliminate. We have a long list, my arbitrary selections are:

Questions and Answers

  • Q: “Vit D is negative”: My vitamin D is in fact over 150 nmol/l already should I stop?
    • A: Yes. If a value is negative it is likely that taking it will be shifting things in the wrong direction.
  • Q: “Grapefruit daily”: I quickly develop food intolerances. Would every 3 days be reasonable?
    • A: Start with every 3 days, if issues arise, try the supplements. Remember these are just suggestions to be considered and may need to be filtered by your tolerance and costs. This applies to your next question too “The same problem for the herbs: Would every 3 days be enough? Also can I just add multiple herbs to my food or are these also “One thing at a time, no juggling”?“
  • Q: This might be a dumb question: Is the suggestion all three bifidobacterium in a row, or just pick one of them and then Mutaflor?
    • A: There are never dumb questions. The sequence is arbitrary. Proceed as you feel comfortable. Bifidobacteria is likely to have a greater effect.
  • Q: B Vitamins and Amino acids: Also one thing at a time? I know I’m asking this question again, but I am really unsure because if I do all the suggestions in a row it seems it might take like a year..
    • A: Do them all at once or in groups. The reason for doing things in rotation are for items that bacteria are likely to adapt to (i.e. bacteria resistance). These items are typically probiotics (which produce natural antibiotics), antibiotics and a herbs/spices with significant antibiotic like effects. These are not such items.
  • Q: My mom suggested me N-Acetyl-L-Cysteine which helped her a lot, and I want to look that up.
    • A: It is there, N-Acetyl Cysteine (NAC), with a solid positive value (247).
    • Feel free to inspect that list and create your own set of suggestions. These are suggestions only based on your microbiome and computation. For ME/CFS, I try to highlight items seen to have positive effects in studied. You may wish to search CFSRemission for literature on items you decide to try.

Postscript – and Reminder

I am not a licensed medical professional and there are strict laws where I live about “appearing to practice medicine”.  I am safe when it is “academic models” and I keep to the language of science, especially statistics. I am not safe when the explanations have possible overtones of advising a patient instead of presenting data to be evaluated by a medical professional before implementing.

I can compute items to take, those computations do not provide information on rotations etc.

I cannot tell people what they should take or not take. I can inform people items that have better odds of improving their microbiome as a results on numeric calculations. I am a trained experienced statistician with appropriate degrees and professional memberships. All suggestions should be reviewed by your medical professional before starting.

The answers above describe my logic and thinking and is not intended to give advice to this person or any one. Always review with your knowledgeable medical professional.

A Long Complex Request after COVID

This person gave an extensive history – the microbiome reflects recent events in general so I have skipped most of it because of that.

An analogy may help, bacteria can be viewed as a city, say London or New York. An “event” happens, for example the Irish Potato Famine, or a shortage of labor causing the import of people from the colonies. The culture of the city is challenged. People are displaced and will often push back; fight back. Eventually a new status quo is established — it does not happen overnight, but over years; over decades. Returning to the old ways (London full of Saxons; New York full of tribal Indians) may be dreamt of, but never happens. An infection is a new wave of immigrants into the city. The impact does not always reflect the numbers. A small number of drug traffickers can have a huge impact on a city. This is how I think about the microbiome — a dynamic living city of bacteria that keeps changes over time. Ghettos develop where once stately manors of well-to-do people were.

Recent Back Story

In September of 2022, I had a COVID infection and fever, which caused a significant “crash”. I have been mainly bedridden ever since. Though the severity of symptoms I experience has waxed and waned from then until now, there has not been any significant differences in ability since. My symptoms are varied, and I’ve noted the ones experienced the week I took my sample on Microbiome Prescription. Positively, I have recently experienced a lowering of resting heart rate with regular electrolyte consumption, HR based pacing, NSDR, and diaphragmatic breathing. Starting Low Dose Naltrexone has helped with pain management, and I’ve needed to take less naproxen as a result. 

I’ve tried oxaloacetate and pregabalin to no effect, had some significant side effects with duloxetine, and had a severe reaction with no benefits when I tried CBD/THC oil.

An interesting point is that my microbiome seems more similar to those Covid19 “Longhaulers” than to those with ME/CFS. I wonder why that may be, given that I had ME/CFS before my Covid infection?

I view both Long COVID and ME/CFS to be the same condition with one key difference. Long COVID is a recent major disruption of the microbiome. ME/CFS is often an ancient disruption that has evolved into a more stable state. Long COVID is typically an unstable microbiome that has a high rate of change. See this post on ME/CFS outbreak traced to a specific community infection. Some microbiome return to a stable normal state over time (a.k.a. remission). Going back to the cities examples above, Long COVID is akin to the mass migration of African Americans to Chicago after the civil war. ME/CFS is the state of Chicago today.

This person’s back history included:

  • “Chronically anxious child with perfectionism tendencies” this pattern has been associated with ME/CFS by many. In terms of the microbiome, the stress would have significant impact on the microbiome.
  •  “Asthma” which has known microbiome shifts
  • Severe constipation that required hospitalization, again know microbiome shifts. She has taken Polyethylene Glycol regularly. This is known to cause microbiome shifts.
  • Taking fludrocortisone (fludrocortisone) and duloxetine for several years.
  • Crohn’s disease, though the biopsies from the digestive tract were inconclusive. Again known microbiome shifts.

What does this mean? There is a massive amount of “microbiome noise” from these medical conditions and significant drugs. This could be classified as a hodge-podge of a microbiome.

Other questions I have regarding my sample:

Based on my sample, is it possible to tell the likelihood I have (or eliminate the possibility I have)…

  • poor gut motility
  • MCAS/Histamine issues
  • Specific intolerances such as gluten or dairy
  • SIBO
  • Leaky Gut
  • Celiac

Basically, can I extrapolate from the data if I may have issues to fix regarding one of the above or if I can say with some certainty that these don’t affect my gut health?

No, it is not really possible to tell the likelihood. The best that you can do is whether you have bacteria associated with those conditions. Association main purpose is to augment or suggest additional medical tests. Some examples:

  • Special Studies:  
    • 12 % match Poor gut motility (your highest was 30% for Long COVID)
    • 13 % match Allergies And Food Sensitivity
    • 10 % match MCAS/Histamines
    • 8 % match Small intestinal bacterial overgrowth (SIBO)
  • Pub Med:
    • Small Intestinal Bacterial Overgrowth (SIBO)   (0 %ile) 0 of 21 – so unlikely
    • Celiac Disease   (38 %ile) 3 of 70 – so unlikely
    • Postural orthostatic tachycardia syndrome   (0 %ile) 0 of 6

The PubMed one that you are highest in is Colorectal Cancer (with 9 of 38 matches). This some some resemblance to her recent medical history.

Around August 2020, I started experiencing rectal bleeding, abdominal cramping, mouth sores, and rectal prolapse. I had a colonoscopy and endoscopy in Dec. 2020 with general anaesthetic, and it was as if I had been “hit by a truck”. I could barely get out of bed for the next 5 months. I was diagnosed with Crohn’s disease, though the biopsies from my digestive tract were inconclusive…. Some other anomalies found include a potential cyst on my right ovary and a tender and enlarged lymph node near my right armpit. The cyst and fluid sac may just be “the more you look, the more you find”.

I seem to be intolerant to (or not digest very well) dairy products (with or without lactose), processed foods, acidic fruits (such as raspberries, oranges, lemon or pineapple), starchier foods, oils and fats, lentils, onion, garlic, asparagus, almonds, cucumbers, broccoli, tomatoes, chai, rice crackers, etc. With some foods, such as gluten or eggs, it seems to vary as to whether I tolerate it well.

My medications at the time of the sample were:

  • Low Dose Naltrexone 3mg
  • Nadolol 40mg
  • Multivitamin
  • Vitamin D 2000iu
  • Vitamin C 500g
  • Naproxen as needed for menstrual and joint pain

Since then, I’ve added these supplements:

  • Magnesium Glycinate 90mg TID (total 270mg)
  • Inulin 1tsp 
  • Align Probiotic 1 capsule
  • Probiotic 3 1 capsule TID (total 3 capsules)
  • Tributyrin-x 3 capsules
  • D-Ribose 5mg

Analysis

Unlike most Long COVID and ME/CFS microbiomes, the percentage in each percentile is well balanced in the percentages in each percentile. This may be due to items like Low Dose Naltrexone and other medication, or her complex medical history. In terms of Shannon Diversity Index, it was high 2.07 / 97.1%ile.

Switching over to Bacteria Deemed Unhealthy, we see a very long list. Some of these are associated with MCAS and allergies. This is a much better signature than the above ones.

Going over to KEGG AI Computed Supplements, we see a long list, much longer than typical. Items over a Z-Score of 2 are strong candidates for taking as supplements. These are chemicals consumed by bacteria or the body and thus suggests starvation of bacteria (with misbehavior likely).

Looking at AI computer probiotics, nothing stood out strongly. Enterogermina (Bacillus Clausii) is the strongest suggestion.

Analysis of What Is Currently Being Taken

The following times were listed above, I did the “just give me suggestions” and the looked at the full detail via the consensus report. Usually the consensus report highest value is around 400; her report went up to 753 and down to -1064. This is far more variation than I usually see!

  • Low Dose Naltrexone 3mg – GOOD, 496.4 (max was 753.
  • Nadolol 40mg – GOOD, 496.4
  • Multivitamin
  • Vitamin D 2000iu – so so, -15
  • Vitamin C 500g – positive: 400
  • Naproxen as needed for menstrual and joint pain — Good 496.4
  • Magnesium Glycinate 90mg TID (total 270mg) – negative -355
  • Inulin 1tsp  – BAD, -732.4
  • Align Probiotic 1 capsule – bacillus coagulans – so so, -14
  • AOR Probiotic 3 – 1 capsule TID (total 3 capsules)
    • Enterococcus Faecium – so so (-22, -172), to negative
    • Clostridium Butyricum – negative – 306
    • Bacillus Subtilis – so so (-19,-48, -315) to negative
  • Tributyrin-x 3 capsules – so so -12
  • D-Ribose 5mg – negative -200

Remember: these are fuzzy logic computation based on fragmentary data available from existing studies. In general, readers have reported improvement from the suggestions – but the suggestions are plotting courses in a fog bank… so do not become dogmatic about doing or not doing.

So what is suggested instead?

Well, all of the prescription items above are big thumbs up! 🙂

Questions and Answers

Q:  It seems that my microbiome is very well balanced, but has many unhealthy bacteria and a much more varied consensus report than usual. With other similar results from others, do you see a common reason or cause for this being the case? 

  • A: I would not call it well balanced. Several measuring sticks show no strong pattern, but given the large number of microbiome affecting things that have happened to you, those events have likely added a lot of noise. The abnormally large number of bacteria deemed unhealthy is the signature thru this noise. This is not a common situation. Most people have just one microbiome affecting thing.

Q: Being in the 0% percentile for POTS seems interesting for me, given that my POTS is still not quite stable. What are the usual reasons for a microbiome not matching the symptoms and diagnosis of a particular condition (especially that I’m only a 12% match for MECFS with/out IBS)? 

  • A: Similar to above, compounding conditions and treatments that alters the microbiome is a multitude of ways. Ideally, we want to see patterns but patterns usually arise from “pure cases”, you are not a pure case, but a highly compounded case.

Q: Given I have the highest association to Colorectal Cancer, how important is this? Is this something I should be looking to screen for or is it of low enough significance to ignore somewhat?

  • A: In the abundance of caution, I would ask for screening, you have one recognized risk factor with a hint also from your microbiome. Per CDC guidelines (helps persuade MDs) “However, you may need to be tested earlier than 45, or more often than other people, if you have— Inflammatory bowel disease such as Crohn’s disease or ulcerative colitis.” [CDC]

Q. I’m currently taking magnesium mainly as a tool to manage muscle spasms and twitches. Is there a supplement with similar effects that has a better consensus value?

  • A: What I did was search the US National Library of Medicine for possible alternatives.
    • Lactobacillus paracasei is cited [2004] “Lactobacillus paracasei, but not Lactobacillus johnsonii, Bifidobacterium lactis, or Bifidobacterium longum, attenuated muscle hypercontractility.”
      Unfortunately a negative.
    • Streptococcus thermophilus and Lactococcus lactis [2022] “Spasm reductions were accompanied by specific gut microbial alterations, including increases in Streptococcus thermophilus and Lactococcus lactis. Mimicking the fecal microbial alterations in a targeted probiotic, we administered these species in a 5:1 ratio. Targeted probiotic administration reduced seizures and improved locomotor activities in control diet-fed animal”
      – No information, so these two would be my first preference.
    • From other articles, there appear to be associations of spasm and twitches with mineral imbalances. For example, hypokalemia(low potassium) [2023]
      – I would suggest explicit testing for mineral balances

If you have a willing MD, I would ask for amoxicillin which is a common antibiotics and has the second highest confidence of having an impact. The top one, Imipenem, is an intravenous β-lactam antibiotic and it’s impact on the microbiome is less certain. Remember, most MDs will only prescribe for acute active infection and a microbiome dysfunction/issues may not be sufficient for them.
My next choice would be thyme oil and hesperidin supplements. With the thyme oil — definitely start with a low dosage and expect bacteria to be protesting strongly (often they protest by massive dumping of toxins into the body… they do not go out quietly).

If you try these suggestions and notice changes, I would suggest another test in 8-10 weeks to see what changed and what your next course correction will be.

Postscript – and Reminder

I am not a licensed medical professional and there are strict laws where I live about “appearing to practice medicine”.  I am safe when it is “academic models” and I keep to the language of science, especially statistics. I am not safe when the explanations have possible overtones of advising a patient instead of presenting data to be evaluated by a medical professional before implementing.

I cannot tell people what they should take or not take. I can inform people items that have better odds of improving their microbiome as a results on numeric calculations. I am a trained experienced statistician with appropriate degrees and professional memberships. All suggestions should be reviewed by your medical professional before starting.

The answers above describe my logic and thinking and is not intended to give advice to this person or any one. Always review with your knowledgeable medical professional.


Microbiome Suggestions for Autism — Cross Validation

Microbiome Prescription uses over a million rules to generate suggestions on improving the microbiome and hopefully reduce or moderate autism behavior. All of the sources of the rules are studies on the US National Library of Medicine. Microbiome Prescription also can provide the complete evidence trail for every suggestion! That is, where — precisely– is all of the information coming from — none of it is private personal opinion or speculation.

An older post on Validation may be worth reading. Also see Cross Validation of AI Suggestions for Nonalcoholic Fatty Liver Disease

Cross Validation

Cross validation is the process of taking one set of information to generate forecasts or suggestions and then look at a totally independent source of information to see if the forecasts and suggestions are valid, reasonable, and appear to help individuals with the condition. I have done that for several conditions with very good results. NOTE: Everything is generated by code — code that I prefer to improve or correct. I have no personal stake in the suggestion, nothing to defend.

Source of Suggestions

Simple,  Candidates which is based on bacteria shifts reported from studies for autism:  Taxons. These two links are on the Medical Conditions with Microbiome Shifts from US National Library of Medicine page

The process is simple: some items may have been tests in trials for autism, some have not. If it has been tried, we see what the result in and provide a link to the study (open data!! no “trust me, I am an expert” hype)

Score?

  • Five items with no information
  • Two items with weak information (not PubMed)
  • Twelve items with confirmed information (PubMed)
  • One item that is complex/questionable – depends on the child’s DNA

The goal / objective of Microbiome Prescription is to make suggestions that are more likely to help than to hurt. That goal seems to be accompanied. A secondary goal is to suggest items that have not been studied but modelling suggests that it may be of benefit to try. We have 5 such items above.

Remember these are GENERIC Suggestions for GENERIC Autism

The results of an individuals microbiome will be different — there are many variants and subsets for Autism. Each variant will tend towards their own set of variations for the microbiome. Using an individual’s microbiome sample will get suggestions unique for them.

Postscript – and Reminder

I am not a licensed medical professional and there are strict laws where I live about “appearing to practice medicine”.  I am safe when it is “academic models” and I keep to the language of science, especially statistics. I am not safe when the explanations have possible overtones of advising a patient instead of presenting data to be evaluated by a medical professional before implementing.

I cannot tell people what they should take or not take. I can inform people items that have better odds of improving their microbiome as a results on numeric calculations. I am a trained experienced statistician with appropriate degrees and professional memberships. All suggestions should be reviewed by your medical professional before starting.

The answers above describe my logic and thinking and is not intended to give advice to this person or any one. Always review with your knowledgeable medical professional.

KEGG Supplement Suggestions Updated

The KEGG: Kyoto Encyclopedia of Genes and Genomes provides detail information on the enzymes by strains. These enzymes determine what is produced and consumed. Not 100% guaranteed (enzyme activation depends on multiple item), but sufficient to use Fuzzy Logic on it.

I had taken a first crack at using this information a few years ago without outstanding results, and had marked the option as being deprecated.

This last week, I got this email from a reader

Another experiment , taking 500mg of tyrosine. Old test showed low dopamine and noriepinephrine . Man I feel so much better. My ADD symptoms went away and i can lock in and get so much done. Energy is better. The question is, why does that work so well , I eat meat all the time and protein powder? Why was my dopamine/noriepinephrine low to begin with , what is the cause and how do I fix it so I don’t need to supplement 🤔🤔🤔

Open to ideas, thanks!!

My first step was to find the old menu item where estimates for compound produced and consumed are calculated. His level for tyrosine net was very very low. Hence, connecting the dots — we see why the supplement improved things for him.

The second part was more interesting. How to avoid a need to supplement? His levels being very low means looking at the bacteria that consumes and produces it with a goal of changing them.

Update Menu Item

This is on the Changing Microbiome Tab

Clicking it will show the estimates for your microbiome.

As with most things microbiome, the distributions are never normal. To facilitate picking the best items to focus on for experiments. You want a low percentile and a large negative z-score. A positive z-score indicates that the number is above the average (mean) and likely not to be concerned above.

There are 4 items listed that I would suggest experimenting with — by experiment I mean, try taking supplements (one at a time) for 2 weeks each and see if there are any subjective changes. For me the items are:

  • Phenylalanine
  • Leucine
  • Valine
  • Isoleucine

Clicking on too few will show which bacteria. This may be a blank table.

Clicking too many will show the consumers

You can then hand-picked bacteria that you are interested in altering.

Bottom Line

This is intended to be used experimentally — that is, the suggested supplements should be tested. Ideally with objective measurement, but with the reality of time delays and costs, subjective measurements may be the best that is practical.

If the supplement helps, then (and only then), you should try to alter your microbiome to correct the microbiome imbalance.

Identifying Supplements you may need from KEGG data and your microbiome. – YouTube

What is looked for:

  • Alanine
  • Arginine
  • Asparagine
  • Aspartic acid
  • Biotin (Vitamin H)
  • Carnitine
  • Cysteine
  • Folate (Vitamin B9)
  • Glutamic Acid
  • Glutamine
  • Glycine
  • Histidine
  • Isoleucine
  • Leucine
  • Lysine
  • Malic Acid (L-Apple Acid)
  • Methionine
  • NAC (N-Acetyl-L-cysteine)
  • NADH (Nicotinamide adenine dinucleotide)
  • Phenylalanine
  • Proline
  • Riboflavin (Vitamin B2)
  • Serine
  • Thiamine (Vitamin B1)
  • Threonine
  • Tryptophan
  • Tyrosine
  • Valine
  • Vitamin B12(Cobalamin (III) Cob(III)alamin )
  • Vitamin C (Ascorbate)
  • Vitamin D2(Ergocalciferol )
  • Vitamin D3(Cholecalciferol Calciol )
  • Vitamin E (alpha-Tocopherol)
  • Vitamin K
  • Vitamin K2 (Menaquinone)

My ME/CFS Recovery in Objective Microbiome Measurements

For more analysis of ME/CFS and Long COVID see this list.

Percentile’s Percentage

Below are my numbers during a flare — I had the typical over-representation of 0-9%ile seen in most ME/CFS and Long-COVID samples.

After going into Remission, the low percentile counts dropped massively

Alpha Diversity

During Flare

After going into Remission, the two Diversity Index increases significantly. Common belief is that the higher the diversity indices, the better it is for a person. Diversity index typically decreases with age as age related conditions increase.

Dr. Jason Hawrelak Recommendations did not reflect the change. At 98.8%ile during the flare and dropping to 89%ile with remission.

In the Bacteria Deem Unhealthy, Rickettsia was at 77%ile, Legionella was 100% and our anti-inflammation bacteria Faecalibacterium prausnitzii was done to 16%ile [Human CD4+CD8α+ Tregs induced by Faecalibacterium prausnitzii protect against intestinal inflammation]. With remission the first two bacteria disappeared and Faecalibacterium prausnitzii went up to 87%ile.

Seeing the Rickettsia spike reminds me of Cecile Jadin’s work from the 1990’s where this bacteria was very frequently identified in ME/CFS patients using specialized tests.

Bottom Line

We have some clear patterns associated with ME/CFS and Long COVID. It is my belief that the microbiome is a very significant player in this condition and that by correcting abnormal shifts by diet, supplements, antibiotics, etc, remission is probable for many. How to correct is very specific to an individual’s microbiome. There is no universal protocol.

More on Alpha Diversity Indices

Alpha Diversity Indices are not useful in determining how to improve your microbiome. They can be useful to see if your microbiome is improving. Below, I have a table from on long time user of the site below. There was COVID around Jan 2023 and other issues too.

We can see that all of the three indices are moving towards 50%ile, that is typical, overtime. What is ideal for each index is poorly defined. As you can see below — indices averages changes by age so an goal would be to have an index associated with a age younger than you are.

See Symptoms versus Alpha Diversity Indices for the first pass on this topic.

How do we get to this table? Go to Multiple Samples tab and then select Multiple Samples Comparison as shown below.

Then just pick the desired samples. They must all be from the same lab.

Enhancement

On the Research Features tab, we have our new panel. The numbers are now lab specific. The Diversity numbers can be very dissimilar between labs. We have also added information on diversity seen for different self-reported symptoms.

This page can be very interesting to explore. For example Some indices decreases as you age, and other increases. If you want to slow aging (and thus age related medical conditions), you want to work at changing the indices a bit (how is not clear).

For a condition like Long COVID we see that the Shannon Percentile is at 32%ile, i.e. a drop in different species. This matches what is seen with ME/CFS

The Literature

We find some of the above results reflected in study

Bottom Line

None of these indices lead to treatment suggestions. They will be cited in studies on occasion. The lab breakdown by symptoms is likely better data then what will be found in studies — because the distribution is dependent on the lab, i.e. part of The taxonomy nightmare before Christmas…

ME/CFS for 2/3 of their life, then multiple COVID

Backstory

I think my case is unique and interesting.  I have had CFS/ME for 37 years since age 15, but I have been very functional for the most part.  I had been worsening over the past 8-10 years and discovered high mold levels 3 years ago in my house.  I developed MCAS and related symptoms from the mold.  But with treatment I was improving ( See Pre-COVID Thryve sample which is quite good.)

Then contracted COVID in Nov 2021.  I had a moderately severe acute COVID illness and did not recover fully, developed Long COVID.  Shortness of breath, low o2 sat, palpitations,  dysautonomia, insomnia, irritable bladder, cognitive issues much worse than CFS/ME. My GI issues were not too bad though.  Diarrhea on and off for several weeks.  Gas and bloating that aligned with my MCAS fluctuations.  I did have a GI Effects test done during this time (Feb 2022) and it wasn’t too bad (5 score on dysbiosis 0 or 1 on other markers, 2 on inflammation.  I know the limitations of that test. 

My health steadily improved and as of 2 months ago I was 85% from my pre-COVID health.  But contracted respiratory illness, most likely COVID again.  Sore throat, congestion, GI issues.  Took 3 weeks to resolve sore throat and congestion but GI issues have worsened over the last 5 weeks.  Alternate between diarrhea and constipation, gas, cramping, MCAS worse.  Passed out earlier this week when experiencing cramping.  Had strange derealization experience at that time, kind of like a flashback or deja vu.  Fatigue and cognitive issues are getting worse as well.  

Analysis

My tell-tale test for ME/CFS and Long COVID is massive over-representation of the 0-9%ile. The number in each percentile range should be around the same in a normal microbiome. These are often different from patient to patient. For other ME/CFS or Long COVID analysis, see this page.

PercentileGenusSpecies
0 – 95172
10 – 191218
20 – 291818
30 – 391418
40 – 491620
50 – 591920
60 – 691319
70 – 792618
80 – 891718
90 – 991722

Looking at Dr. Jason Hawrelak Recommendations, we see a lot of items out of position.

TaxonomyRankLowHighYour ValueStatusHand Pick
Bacteroidiaclass03537.085Not Ideal
Akkermansiagenus130.354Not Ideal
Bacteroidesgenus02031.372Not Ideal
Bifidobacteriumgenus2.550.005Not Ideal
Blautiagenus51011.271Not Ideal
Desulfovibriogenus00.250.028Ideal
Eubacteriumgenus0150.177Ideal
Lactobacillusgenus0.0110.006Not Ideal
Methanobrevibactergenus0.00010.020Not Ideal
Roseburiagenus5100.472Not Ideal
Ruminococcusgenus0155.567Ideal
Proteobacteriaphylum048.94Not Ideal
Bilophila wadsworthiaspecies00.250.093Ideal
Escherichia colispecies00.010Ideal
Faecalibacterium prausnitziispecies10152.902Not Ideal
Overall Percentile Ranking56.5% 

One item to note is Bifidobacterium which appears to be associated to allergies and potentially MCS (see Mast Cells and Bifidobacteria)

The Bacteria deemed Unhealthy list had some interesting items:

  • Rickettsia at 99%ile and Ehrlichia at 96%ile — this genus was the focus of Dr. Cecile Jadin work with ME/CFS over the last 3 decades. I recently did another post on these High Tick-borne Bacteria Counts (P.S. Dr. Jadin is working on a draft of her current protocol for this site — stay tune)
  • Faecalibacterium prausnitzii species at 17%ile, Reduced Ability to handle inflammation

As with another person who had ME/CFS and then Long COVID, let us look at the matches to published literature:

  •  Long COVID   (62 %ile) 14 of 204
  •  COVID-19   (59 %ile) 11 of 118
  •  Chronic Fatigue Syndrome   (60 %ile) 4 of 64
  •  Irritable Bowel Syndrome   (80 %ile) 10 of 68
  •  Allergic Rhinitis (Hay Fever)   (98 %ile) 6 of 39

Other matches were interesting, Insomnia   (0 %ile) 0 of 26, which implies that sleep issues are likely atypical. These are very rough estimates (the studies were done with different lab processes, so the data is fuzzy).

Going Forward

I started with the “Just give me Suggestions” and then manually did the 5 items above. Why? To give emphasis to the likely bacteria that may be of main concerns. So we see:

The highest (and lowest) priority were 466 and -453. So our emphasis would be items over 233 and below 227 to give us the best odds. Yes, odds — everything is done by fuzzy logic and probability.

The top easy to do items are:

Flipping over to the other side, items to reduce or avoid if possible:

I have often suggested barley or oats porridge with walnuts for breakfast each day — that provides lots of fiber. As for milk with it– Yakult — which contains lactobacillus casei (probiotics). And cacoa / chocolate — see Honestly! Chocolate!!! [2012], Bifidobacterium, Chocolate and CFS [2014] and Chocolate & Blueberries– Good Medicine for Bifidobacteria [2017]. All of the following are positives: blueberry, whole-grain barley, oats and barley,oat.

Going over to Retail probiotics, see several safe(no adverse impact detected) one including: symbiopharm / symbioflo 2, enterogermina and Filmjölk (SE) / Filmjölk (hard to get outside of Sweden).

Flipping over to Food Menu Planner we see a short list of high priority items. The top one: inulin and fiber cited above are a convergence… but what about the other oddities?

👍100Inulin
👍61.111,4-Naphtoquinone — in Walnuts Liquor
👍53.01Isoferulic acid — vinegar
👍43.39Raffinose — in
Artichoke, jerusalem, peeled, boiled, drained (which is also used for inulin)
👍34.1302 mers — Chocolate, dark
👍31.71Oligosaccharides — Pea, split, dried (or supplements)
👍31.25Naringin — Grapefruit
👍30.22Apigenin 7-O-glucuronide — Globe artichoke, heads, raw

As a reminder, many studies use the above nutrients (and the food it comes from may not have been studied). The Food Menu attempt to resolve this disconnect. So Artichokes of different types should be regularly on your supper menu — perhaps with pea soup or just boiled peas.

Questions

My current diet (low carb, higher saturated fat, high red meat) is a poor choice according to these results.  The low carb approach works well for my blood sugar and for keeping my weight down, but I do crave good carbs.  I eat a lot of vegetables but it is impossible to get enough fiber that way.  I had been supplementing with a rotation of psyllium, flax and chia. I will slowly adjust my diet to a higher carb, lower fat one and see how I respond.  I have done well with oats in the past. I think as long as I combine the starches with lean protein I will do fine. 

I used inulin during my first Covid infection and seemed to do well with it.

With regard to probiotics, bacillus subtilis looks to be a great choice, but different strains are used in the studies and most are not available commercially.  The one commercially available  microbiome labs /hu58 is marginally “likely safe”. 

I am going to try Yakult.  What would be your second choice? 

Nicotine is interesting.  This was talked about early on as being protected for Covid.  Now it is gaining popularity as many are trying for Long Covid.

It is disappointing there are no strong consensus herbs or spices.  

Feedback.

A: Concerning Probiotics, there is a second approach — looking at the genes you have in your bacteria and what they are not producing enough of.

The top 1 is Escherichia coli — available in two products: Mutaflor and Symbioflor-2. The next ones that are relatively easy to obtain are Bacillus subtilis and a specific species: Bacillus subtilis subsp. natto. This later item is available in many Japanese food sections of some grocery stores. It is just called Natto. It is made using soy which is also on your positive list. It also is a fibrinolytic (unthickens thick blood).

Q: “Should I consider rosemary stronger because of ursolic acid?”

A: No, the numbers indicated confidence of the item having a positive or negative effect. They are not “better” or “stronger” numbers, just more likely to have some effect (may be minor). We are using fuzzy logic, hence odds and the odds are on causing shifts and NOT the amount of shift. That is all that we can get from the studies usually.
Bacillus subtilis subsp. natto

Bottom Line

This microbiome matches the pattern for ME/CFS and Long COVID. Most of the suggests have been studied with ME/CFS with positive results. Now it is just a matter of doing. After 6-10 weeks do another microbiome sample so you may make the next course adjustment. Most people cascade into ME/CFS, getting out is a dog-legged journey.

Addendum Exploration

I decided to look how the indices change with age. As you can see below, in general they decrease or increase significantly with age as I would expect. For more information see this earlier post.

.

Symptom NameShannonSimpsonChaoShannon
Rank		Simpson
Rank		Chao
Rank		Obs
Age: 0-101.5760.118878833.165.244.821
Age: 20-301.5990.0651159232.249.752.657
Age: 30-401.5790.061111931.943.552.9153
Age: 40-501.620.0671043334.847.150.5106
Age: 50-601.6050.0451172832.834.155.347
Age: 60-701.4880.03313580282660.722

Alpha Diversity Indices:

For a general introduction.. Personally, they are unlikely to be useful in an individual context and are complex to fully understand. I include this as an exploration

  1. Shannon Diversity Index: 1.39 / 16.3%ile
    • Closest to: Comorbid: Salicylate sensitive;Other: Sensitivity to vibrations;Neurological-Vision: Blurred Vision;DePaul University Fatigue Questionnaire : Tingling feeling;DePaul University Fatigue Questionnaire : Blurred Vision;Immune Manifestations: Thick blood / Hypercoagulation
  2. Simpson Diversity Index: 0.04 / 31.2%ile
    • Closest to: Age: 60-70; Neurological: fasciculations; Other: Sensitivity to vibrations
  3. Chao1 Index :16371 / 76.6%ile
    • Closest to: DePaul University Fatigue Questionnaire : Does physical activity make you feel better; Age: 60-70; Comorbid: Restless Leg; Onset: less than 08 years since onset; DePaul University Fatigue Questionnaire : Chemical sensitivity

Symptoms versus Alpha Diversity Indices

I recently exposed the Diversity Indices to all users on Microbiome Prescription. It is on the [Research Features] tab.

I then computed the average and also the average percentile for each symptom. I prefer to use percentile because the distribution is not a bell curve. Converting to percentiles transform it to a uniform distribution which is easier to work with for statistical tests. Percentiles are also easier for people to understand.

See this write up by CosmosId to explain these indices. I also attach the data as a CSV file for those who want to play with sorting the data in different manners. For all of the Rank, 50 is what would be expected from a general healthy population.

These Measures are Age And Lab Sensitive

Symptom NameShannonSimpsonChaoShannon
Rank		Simpson
Rank		Chao
Rank		Obs
Age: 0-101.5760.118878833.165.244.821
Age: 20-301.5990.0651159232.249.752.657
Age: 30-401.5790.061111931.943.552.9153
Age: 40-501.620.0671043334.847.150.5106
Age: 50-601.6050.0451172832.834.155.347
Age: 60-701.4880.03313580282660.722
Biomesight
SymptomNameShannonSimpsonchaoShannon RankSimpson RankChao Rankobservations
Age: 20-302.180.0623606549.615.238
Age: 30-402.1160.06205861.650.313.969
Age: 40-501.8480.071172447.853.911.753
Age: 50-601.7470.039201942.832.513.947
Age: 60-701.9260.058169152.143.711.475
ubiome
Symptom NameShannonSimpsonchaoShannon RankSimpson RankChao Rankobservations
Age: 0-102.2930.1341979764.167.769.852
Age: 20-302.6160.1032154974.863.269.131
Age: 30-402.8160.0831639481.763.467.296
Age: 40-502.890.092027584.862.274.153
Age: 50-603.0250.0762195686.65475.938
Age: 60-702.5960.0772774072.45172.672
Ombre/Thryve Data

For anyone wishing to dig further, all of the raw data is on our citizen science site for download. For example, you can compute lab specific percentiles for each symptom.

DiversityDownload
Symptom NameShannonSimpsonChaoShannon RankSimpson RankChao RankObs
Asymptomatic: Minor Health Issues (a few symptoms only)1.9310.0484856.98350.740.52658
Official Diagnosis: Ulcerative colitis1.7050.085547.47835.254.727.523
Neurological: Spatial instability and disorientation2.0490.0725981.80455.251.829.556
Asymptomatic: No Health Issues2.0120.0668924.89953.745.429.6188
Joint: Sudden and severe episodes of pain2.1850.0586160.83358.548.530.648
Neuroendocrine: Feeling like you have a high temperature1.9670.0756704.37350.953.832.675
Autonomic: Blurred or tunnel vision after standing1.9070.0546777.78449.942.133.251
Neuroendocrine Manifestations: abnormal appetite2.0120.067345.45553.244.834.177
Neurological: fasciculations1.8630.0558333.947.943.334.270
Onset: over 31 years since onset1.6570.0897253.21938.747.234.632
Neurological: Confusion1.9180.0677627.78549.448.43593
Immune Manifestations: Diarrhea1.9360.07512798.5748.952.435178
Neuroendocrine: Feeling like you have a low temperature1.9630.0697193.58351.54835.360
Neurological-Vision: Blurred Vision1.8670.0597616.11946.44435.4151
Autonomic: Graying or blacking out after standing2.0370.0587603.08655.945.335.535
Neuroendocrine: Chills or shivers1.8130.0837818.41145.252.635.656
Neuroendocrine Manifestations: recurrent feelings of feverishness1.9750.0598146.89251.24836.265
Neurological: Difficulty processing information (Understanding)1.90.0718249.88348.348.136.3197
Neuroendocrine Manifestations: Neuralgia1.910.06710588.1447.249.636.444
Neurological-Sleep: Chaotic diurnal sleep rhythms (Erratic Sleep)2.0090.05911433.4551.643.436.5231
Neuroendocrine: Temperature fluctuations throughout the day1.9570.0657482.10349.850.336.568
Neurological: Impairment of concentration1.9810.05910024.1251.643.836.8345
Immune Manifestations: tender lymph nodes1.9810.0578632.26451.643.236.9110
Sleep: Sleeping all day and staying awake all night2.070.0747632.56356.354.337.132
Autonomic: Nausea1.9110.078689.97648.851.737.185
Neurological: Short-term memory issues2.0010.0628048.83252.545.637.2220
Neurological: Neuropathy1.9260.05111019.7648.241.437.571
Official Diagnosis: Metabolic Syndrome1.7480.0678212.52443.344.137.621
DePaul University Fatigue Questionnaire : Fever & Chills1.7280.1029503.59140.556.237.622
Neuroendocrine: Lack of appetite1.9460.0649142.98450.544.537.661
Neurological: Executive Decision Making (Difficulty making)2.0060.06111185.7652.444.437.7289
Immune: Sensitivity to smell/food/medication/chemicals1.9790.0679401.0775047.437.8194
Immune Manifestations: Genitorinary / Nocturia – Urinary issues2.0850.077840.6085651.737.851
Neurological: emotional overload2.0650.0668548.66854.849.537.8196
Neuroendocrine Manifestations: Muscle weakness1.950.0628751.74149.646.237.9216
General: Myalgia (pain)2.0090.05913779.452.446.337.9216
Onset: 2000-20101.9490.0648244.57449.847.338122
Neuroendocrine: Lost or gained weight without trying1.9930.078316.81451.650.738.2118
Immune Manifestations: new food sensitivities1.9830.0679932.41450.647.738.2157
Onset: Gradual2.0430.06213699.925547.638.2172
Neurological: High degree of Empathy before onset1.9750.078434.4655151.138.386
Comorbid-Mouth: Dry Mouth1.8560.0558600.48445.741.338.4124
Neuroendocrine Manifestations: subnormal body temperature1.9990.05712240.3452.140.838.4235
Neurological-Vision: Acquired or exertional dyslexia1.9110.0768275.38149.754.138.521
Neuroendocrine Manifestations: Dry Eye (Sicca or Sjogren Syndrome)1.8730.05610422.6645.742.438.5136
Neurocognitive: Slowness of thought1.9580.06112656.6150.644.938.6361
Neuroendocrine: Sweating hands1.910.0918249.43848.256.638.748
Pain: Chest pain2.1240.06910019.4158.352.338.754
Blood Type: B Positive1.7530.0858271.44440.455.838.736
Neurological-Vision: inability to focus eye/vision1.9460.06112655.2249.642.138.8224
Neurological: Difficulty reading1.9660.06611904.1350.545.139283
Neurological-Vision: Impaired Depth Perceptions1.9170.0939048.09146.349.73933
Asymptomatic: Live in house with person with probable microbiome dysfunction1.9540.0579649.83150.143.23971
Neurocognitive: Absent-mindedness or forgetfulness1.9890.06412091.8151.545.639389
Pain: Pain or aching in muscles1.9580.06812992.849.751.139182
Comorbid: Raynaud’s syndrome (Skin discoloration)1.9170.05215270.644844.73933
Autonomic Manifestations: cardiac arrhythmias1.9550.0549592.80351.440.83961
Pain: Myofascial pain2.0090.06419489.555347.839.189
Neuroendocrine Manifestations: Excessive adrenaline2.0270.0648756.42353.650.539.178
Official Diagnosis: Inflammatory Bowel Disease (IBD)1.9060.0938392.80647.658.539.231
Pain: Joint pain2.0030.06610602.5151.950.639.3178
Joint: Stiffness and swelling2.0410.05912655.6153.14339.3246
Neurological-Sleep: Vivid Dreams/Nightmares2.060.0589058.6754.645.439.3100
Infection: Mycoplasma2.0540.07511920.39545439.4111
Neurological: Disorientation2.1020.0778725.1556.95539.580
Comorbid-Mouth: Gingivits / Gum Disease2.040.068021.0655.747.739.867
Autonomic Manifestations: Cortisol disorders or irregularity2.0150.0648834.63951.847.639.897
General: Headaches1.9910.0612468.851.244.839.9309
Official Diagnosis: Mast Cell Dysfunction2.0120.0613066.2851.843.139.9208
Autonomic: Dizziness or fainting1.9320.0628867.45549.645.539.9112
Immune Manifestations: general malaise1.9620.06113005.8850.544.940339
Comorbid: Hypothyroidism1.9820.06112229.7250.943.540258
Autonomic Manifestations: nausea1.8620.0679328.00946.547.940.1108
Age: 60-701.9970.05714128.2651.240.140.2195
Neuroendocrine Manifestations: Rapid muscular fatiguability2.0240.0639405.63653.446.740.2165
Pain: Aching of the eyes or behind the eyes1.9540.05811520.9349.644.740.398
Immune Manifestations: Alcohol Intolerant1.9670.05912012.2849.941.840.5303
Neurocognitive: Difficulty understanding things1.9420.0719540.41349.849.640.5189
Neurological-Vision: photophobia (Light Sensitivity)2.0040.06312593.7451.244.740.5276
Onset: less than 16 years since onset1.9540.0578948.20549.746.340.783
Autonomic Manifestations: irritable bowel syndrome1.9630.06313226.950.844.240.8378
Neurocognitive: Feeling disoriented1.9760.0659168.40550.849.340.8126
Comorbid-Mouth: TMJ / Dysfunction of the temporomandibular joint syndrome1.9860.05713336.8250.940.240.8223
Autonomic Manifestations: palpitations1.8760.0649256.6544745.940.9133
Infection: Human Herpesvirus 6 (HHV6)2.0560.06814020.1554.249.540.9149
Neuroendocrine Manifestations: worsening of symptoms with stress.1.9890.06110591.7251.144.940.9414
Autonomic Manifestations: Postural orthostatic tachycardia syndrome (POTS)1.9270.0679603.28948.845.240.9128
Onset: less than 04 years since onset2.0340.0738956.18354.153.240.971
Immune Manifestations: Abdominal Pain1.9470.06814265.7649.446.541.1326
Neurological: Word-finding problems2.0570.06410858.3953.546.941.2289
Neurological-Audio: hypersensitivity to noise1.9580.06411562.5349.745.741.2347
Immune Manifestations: recurrent flu-like symptoms2.0010.06615145.9651.848.441.2124
Neuroendocrine: Alcohol intolerance1.9510.0613204.9449.641.841.3278
Post-exertional malaise: Rapid muscular fatigability,2.0240.069815.64552.844.141.4169
Neurocognitive: Problems remembering things1.990.06511390.8151.346.941.4415
Comorbid: Constipation and Explosions (not diarrohea)2.0140.06214823.4752.241.941.5170
Neuroendocrine Manifestations: intolerance of extremes of heat and cold1.9870.0649946.11250.947.341.5249
Pain: Eye pain1.9780.04614356.535137.841.557
Neurological-Audio: Tinnitus (ringing in ear)1.960.06113969.8549.544.841.5392
Blood Type: A Negative1.870.06884547.942.941.524
Neurocognitive: Unable to focus vision and/or attention2.010.06512425.265245.741.6302
Other: Sensitivity to mold2.0430.0679442.87253.550.541.7141
Neurocognitive: Can only focus on one thing at a time1.9810.0611138.7150.74541.7394
Neurological: Cognitive/Sensory Overload1.9880.06710058.0150.749.441.7219
Immune Manifestations: medication sensitivities.2.0920.06113364.0655.544.541.7142
Neurocognitive: Difficulty paying attention for a long period of time2.0020.06411330.785246.841.8429
Immune Manifestations: hives1.9730.05610904.2850.238.641.946
Onset: Sudden1.7040.0688797.21439.947.741.970
Autonomic Manifestations: exertional dyspnea1.7710.0619788.97845.339.94246
Comorbid: Mold Sensitivity / Exposure2.0720.0669522.61354.249.742.1137
Sleep: Need to nap daily1.9550.0619768.21749.746.342.1129
Neuroendocrine Manifestations: sweating episodes2.0740.07113323.8354.647.942.1183
Post-exertional malaise: Inappropriate loss of physical and mental stamina,2.0340.0639683.47852.746.742.1255
Autonomic Manifestations: urinary frequency dysfunction2.0230.078986.06253.649.542.2113
Neurocognitive: Difficulty expressing thoughts1.9960.07410247.5751.849.442.2232
General: Fatigue1.9710.05812031.4650.644.542.3554
Immune: Flu-like symptoms2.0320.06717995.0153.247.342.3116
Neuroendocrine Manifestations: marked weight change2.1150.06913678.2355.350.242.3119
Comorbid-Mouth: Bruxism – Jaw cleanching / Teeth grinding2.0050.06213571.2951.643.242.3318
Neuroendocrine: Feeling hot or cold for no reason1.9850.06710345.5650.548.542.4158
Autonomic: Ocassional Tachycardia (Rapid heart beat)1.9080.0679478.57948.149.242.4121
Gender: Female20.0559736.42751.343.342.4372
Immune: Recurrent Sore throat1.9610.06311439.6749.545.942.5134
Neurological-Sleep: Sleep Apnea2.1480.06619898.158.252.342.6103
Comorbid: Snoring (NOT Sleep Apnea2.0310.05914436.9152.741.642.6185
Sleep: Waking up early in the morning (e.g. 3 AM)2.0570.06212919.9553.34542.7349
Neuroendocrine Manifestations: marked diurnal fluctuation2.1150.0610086.795845.642.724
Immune Manifestations: Mucus in the stool2.0450.07814352.7452.951.642.7176
Neuroendocrine Manifestations: cold extremities1.9610.06114395.249.645.342.8267
Neuroendocrine Manifestations: loss of adaptability1.9630.06522154.925147.442.962
Neurological-Sleep: Night Sweats2.0710.06513304.8853.346.342.9141
Pain: Sensitivity to pain2.0490.07212457.7453.151.142.9181
Immune Manifestations: Bloating1.9770.06313344.0950.34542.9504
Post-exertional malaise: Difficulty reading after mild physical or mental activity1.9910.06510766.6351.24742.9192
Onset: less than 08 years since onset2.0540.0599535.96654.943.34358
Neurological-Sleep: Insomnia2.030.06114473.1752.344.643339
Neuroendocrine: Cold limbs (e.g. arms, legs hands)1.9690.06712977.4950.646.443191
Sleep: Unrefreshed sleep1.9890.05912300.4551.344.143479
Immune Manifestations: Constipation2.0040.05914280.1352.143.243395
General: Depression2.110.06712559.0255.749.143278
Official Diagnosis: Irritable Bowel Syndrome1.9990.06514433.0751.34543.1349
Comorbid: Multiple Chemical Sensitivity2.0530.05612104.9953.941.343.1131
Neuroendocrine Manifestations: Air Hunger1.9310.0589873.46948.844.543.181
Sleep: Daytime drowsiness2.0180.06514393.7352.246.643.1349
Autonomic: Shortness of breath1.9760.0679794.89550.547.843.1124
Immune Manifestations: Thick blood / Hypercoagulation1.990.0619581.98551.246.843.266
Sleep: Problems falling asleep2.0310.06510621.4452.447.843.2221
Infection: Lyme2.0290.05711234.8952.646.843.271
Neurological-Sleep: Inability for deep (delta) sleep2.0970.07114421.5855.948.943.2151
Onset: less than 02 years since onset1.8960.0639318.65746.146.343.367
Onset: 2010-20201.990.06412458.2450.444.743.4325
Age: 10-202.0140.0719357.47553.249.843.440
Autonomic Manifestations: light-headedness1.9880.0710053.8250.449.343.6145
Sleep: Problems staying asleep2.0510.05913891.4952.944.143.7380
Autonomic: Irregular heartbeats2.0470.06814841.5152.84843.8141
Comorbid: Histamine or Mast Cell issues1.9690.05913247.9449.743.543.8355
Other: Sensitivity to vibrations1.9290.04412403.7347.937.343.952
Post-exertional malaise: Mentally tired after the slightest effort2.0180.06310731.3451.547.243.9161
Official Diagnosis: Allergic Rhinitis (Hay Fever)1.9650.05713655.9849.741.643.9232
Infection: Epstein-Barr virus2.1170.0613402.1355.845.444240
Infection: Coxsackie2.10.0619782.61557.347.644.239
Post-exertional malaise: Rapid cognitive fatigability,2.0550.06110488.1953.646.844.2212
Neurocognitive: Brain Fog1.9820.06412153.5850.446.344.3597
Comorbid: Small intestinal bacterial overgrowth (SIBO)2.020.07113923.3151.252.744.4191
Immune: Tender / sore lymph nodes2.0960.06814842.8553.646.744.4111
Post-exertional malaise: Worsening of symptoms after mild mental activity2.0160.07110902.0251.951.444.4165
General: Sinus issues with headaches2.0240.06513296.415246.444.5124
Age: 20-301.9740.0716286.0751.150.944.5136
Post-exertional malaise: Next-day soreness after everyday activities2.1040.06412530.6854.447.244.5198
Immune Manifestations: Inflammation of skin, eyes or joints2.0970.06816251.5554.851.144.6228
Post-exertional malaise: General2.0530.06313379.2153.448.944.6243
Neurological: Slowed speech2.1790.0814630.1157.949.444.7108
Post-exertional malaise: Post-exertional malaise2.0720.0610683.7253.846.344.7269
Neurological: Joint hypermobility2.0630.07215030.9953.348.844.8167
Neurological: Seasonal Affective Disorder (SAD)2.1710.07312976.1858.749.844.9127
Neuroendocrine Manifestations: Laboured breathing2.0030.07711266.0752.151.844.930
Autonomic Manifestations: delayed postural hypotension2.0910.0810730.3256.351.344.928
Infection: Parasite – Other2.0890.07913683.4455.452.244.981
Autonomic: Heart rate increase after standing1.9460.05810621.9350.444.644.9145
Comorbid: Inflammatory bowel disease2.0960.07815575.5554.151.645162
Immune: Chronic Sinusitis1.9690.0569423.87549.444.94580
Neuroendocrine Manifestations: Paraesthesia (tingling burning of skin)2.1770.07515722.6757.352.545.1129
Immune Manifestations: Hair loss2.1110.07517633.8955.253.545.1218
Onset: 1990-20002.1320.05630905.8356.246.345.142
Post-exertional malaise: Physically drained or sick after mild activity2.0920.06311092.955.347.145.1207
Neurological-Sleep: Prolonged Sleep1.9220.0599645.78448.141.645.237
Official Diagnosis: Autism20.08111715.0350.252.345.2207
Age: 50-602.0130.04916092.0250.43745.4142
Official Diagnosis: Chronic Fatigue Syndrome (CFS/ME)2.0460.05213112.6352.840.945.6528
Post-exertional malaise: Muscle fatigue after mild physical activity2.0870.06912312.775450.145.6265
Autonomic Manifestations: Orthostatic intolerance2.0870.06914092.7454.949.745.7164
Comorbid: Fibromyalgia2.0990.07418779.2255.953.246107
Neurological: Myoclonic jerks or seizures1.9820.05311801.649.936.94650
Official Diagnosis: Depression2.1370.06913752.195750.94699
Autonomic Manifestations: bladder dysfunction1.9470.06410480.6350.343.646.156
Official Diagnosis: Fibromyalgia2.0420.07120205.9953.150.846.173
Age: 40-501.9890.07310590.2650.352.146.2216
Joint: Tenderness2.1410.07419366.0656.451.846.2173
Gender: Male2.0660.06714723.2353.54946.2507
Post-exertional malaise: Physically tired after minimum exercise2.0530.06413813.9652.747.546.2268
Post-exertional malaise: Worsening of symptoms after mild physical activity2.10.06212504.3554.646.646.4282
Immune Manifestations: High Altitude Intolerance1.9970.06727233.951.54846.549
Official Diagnosis: High Blood Pressure (Hypertension)2.1490.07924512.0456.762.846.627
Comorbid: High Anxiety2.0850.0661647254.347.446.6302
Blood Type: O Positive2.1070.06114366.5654.843.446.7262
Autonomic: Inability to tolerate an upright position2.1190.07416184.9456.350.247136
Official Diagnosis: Autoimmune Disease2.2170.06918238.2359.449.847.3184
Comorbid: Methylation issues (MTHFR)2.1580.06611514.3557.85247.3113
Comorbid: Restless Leg2.0710.06510681.7354.548.847.493
Official Diagnosis: Mood Disorders2.2940.07410430.1762.857.747.654
Immune Manifestations: Inflammation (General)2.0870.07116527.1754.151.947.6277
Onset: less than 32 years since onset2.0530.06312146.1451.752.747.670
Neurological: Dysautonomia2.0250.06714155.1151.846.947.8156
Age: 30-402.0580.06611989.1553.149.948330
DePaul University Fatigue Questionnaire : Feeling like you have a temperature1.9380.07410889.8847.355.348.243
DePaul University Fatigue Questionnaire : New trouble with math2.190.07211232.0354.957.648.435
DePaul University Fatigue Questionnaire : Chilled or shivery1.9310.07126909.2646.450.948.647
DePaul University Fatigue Questionnaire : Sweating hands1.8590.09110413.7442.255.848.927
Official Diagnosis: COVID19 (Long Hauler)1.6170.08310288.0133.554.348.9203
Comorbid-Mouth: Mouth Sores2.1460.06617904.745545.648.970
Comorbid-Mouth: Ulcers (mouth)1.9640.06211296.4149.645.94927
Official Diagnosis: Osteoporosis1.8880.05410854.1447.140.84921
Immune: Viral infections with prolonged recovery periods2.0660.06611620.8553.648.84999
Comorbid: Salicylate sensitive1.5290.04810532.9230.137.549.136
Comorbid: Mood Swings1.990.0711071.2348.651.549.497
DePaul University Fatigue Questionnaire : Tingling feeling1.7050.07214165.0937.149.149.466
Blood Type: O Negative1.9450.07711344.3347.745.449.530
Comorbid: Electromagnetic Sensitivity (EMF)2.2240.06512963.0860.247.649.539
Neurological-Sleep: Sleep Reversal2.2250.06510837.6760.153.249.633
Neuroendocrine Manifestations: Painful menstrual periods2.1450.05911232.2157.645.449.657
DePaul University Fatigue Questionnaire : Impaired Memory & concentration2.0370.06917173.9851.449.349.7298
Comorbid: Carbohydrate intolerance1.9610.06112491.8951.145.349.946
DePaul University Fatigue Questionnaire : Frequently get words or numbers in the wrong order2.0950.07712878.055354.649.956
DePaul University Fatigue Questionnaire : Chest pain1.9660.07813689.9347.955.450.327
Onset: 1980-19902.0430.04737107.5653.836.750.432
DePaul University Fatigue Questionnaire : Poor Appetite1.9490.05414012.9248.543.750.537
Official Diagnosis: Attention deficit hyperactivity disorder (ADHD)2.0810.07811843.4955.154.850.580
Comorbid-Mouth: Periradicular periodontitis inflammatory / chronic lesion around roots of teeth2.0310.04811195.2454.438.950.625
DePaul University Fatigue Questionnaire : Nausea1.8560.0741235344.351.850.763
Physical: Eastern European1.710.05711299.2136.845.950.834
DePaul University Fatigue Questionnaire : Difficulty reasoning things out1.9550.07811585.794852.950.979
Joint: Redness2.2740.07222181.7261.8505146
DePaul University Fatigue Questionnaire : Blurred Vision1.7660.06211329.2439.445.95162
DePaul University Fatigue Questionnaire : Difficulty falling asleep2.0240.0812073.250.153.851133
DePaul University Fatigue Questionnaire : Unrefreshing Sleep, that is waking up feeling tired2.0620.06816938.435248.951.4334
DePaul University Fatigue Questionnaire : Racing heart1.9530.07522527.5546.751.551.467
DePaul University Fatigue Questionnaire : Feel unsteady on feet2.0260.05713562.4650.137.951.941
DePaul University Fatigue Questionnaire : Fatigue2.0930.06716345.9753.248.852.1380
DePaul University Fatigue Questionnaire : Muscle Pain (i.e., sensations of pain or aching in your muscles. This does not include weakness or pain in other areas such as joints)1.9680.07220265.447.353.152.2117
General: Heavy feeling in arms and legs2.0660.06612763.2253.348.952.3104
DePaul University Fatigue Questionnaire : Upset stomach1.8390.0721705.8242.847.552.379
DePaul University Fatigue Questionnaire : Weight change2.0060.06711665.4550.450.452.560
DePaul University Fatigue Questionnaire : Pain in Multiple Joints without Swelling or Redness1.9460.0615796.9546.649.352.574
Autism: More Inappropriate Social Interaction2.0860.08611929.5454.154.152.624
Comorbid: Constipation and Diarrohea (not explosions)1.9570.06312512.6748.74852.798
Comorbid: Sleep Apnea Diagnosis2.0540.05941891.1952.747.852.747
DePaul University Fatigue Questionnaire : Difficulty retaining information2.0280.06618395.9350.848.653134
DePaul University Fatigue Questionnaire : Mood swings2.140.07312088.4453.352.253.281
DePaul University Fatigue Questionnaire : Shortness of breath2.0310.07212631.2749.147.853.271
DePaul University Fatigue Questionnaire : Difficulty recalling information1.980.06717335.974949.553.2152
DePaul University Fatigue Questionnaire : Eye pain1.8810.05116658.3343.142.953.360
DePaul University Fatigue Questionnaire : Headaches1.9380.07721075.746.751.753.397
Physical: Long term antibiotics(over 6 months)1.9530.08213398.7847.462.553.332
Comorbid: Migraine2.070.07218043.7151.250.553.490
DePaul University Fatigue Questionnaire : Sore Throat1.9640.06814178.0448.445.353.557
Physical: Long term (chronic) stress1.8490.0619406.0543.246.153.5102
DePaul University Fatigue Questionnaire : Forgetting what you are trying to say2.0390.06918515.8150.351.453.6122
DePaul University Fatigue Questionnaire : Night sweats2.0380.06812137.1749.147.153.846
DePaul University Fatigue Questionnaire : Frequently loose train of thought2.1050.07912781.1553.757.353.8107
DePaul University Fatigue Questionnaire : Difficulty following things1.9950.0813048.194953.95489
DePaul University Fatigue Questionnaire : Depression2.0690.06519883.2752.749.75499
DePaul University Fatigue Questionnaire : Allergies1.9210.05912296.6547.245.554141
DePaul University Fatigue Questionnaire : Difficulty comprehending Information1.9720.08312479.6747.754.454.1121
DePaul University Fatigue Questionnaire : Abdomen pain1.9580.07422318.1248.25354.278
DePaul University Fatigue Questionnaire : Hot or Cold spells1.9350.06523234.8847.445.454.268
Blood Type: A Positive2.1670.07816858.155.65354.2112
DePaul University Fatigue Questionnaire : Muscle weakness1.9580.06612329.447.849.454.2123
DePaul University Fatigue Questionnaire : Sensitivity to Alcohol2.0560.06516243.851.646.254.398
DePaul University Fatigue Questionnaire : Difficulty finding the right word2.0310.06917169.1450.849.854.4181
DePaul University Fatigue Questionnaire : Does physical activity make you feel worse2.040.05917569.7851.447.254.5160
Physical: Steps Per Day 2000-40001.8980.05712403.945.541.954.769
Physical: Northern European1.8470.06213131.3143.244.954.7116
DePaul University Fatigue Questionnaire : Temperature lower than normal2.050.0613048.2450.344.854.863
Comorbid: Sugars cause sleep or cognitive issues1.9880.07114434.5651.954.854.832
DePaul University Fatigue Questionnaire : Difficulty staying asleep2.1350.06518877.495448.854.9141
Age: 0-102.0830.11614335.8955.462.654.987
Official Diagnosis: Celiac Disease2.0360.0820864.1551.154.95534
Condition: Acne1.9260.05518545.0447.345.155.180
DePaul University Fatigue Questionnaire : Walking up early in the morning (e.g. 3AM)2.1360.0621152.254.347.755.1102
Autism: More deficits in Language Comprehension2.1180.09312237.6955.860.255.135
DePaul University Fatigue Questionnaire : Confusion/disorientation1.9050.07512532.1745.753.755.160
DePaul University Fatigue Questionnaire : Need to nap during each day1.8690.06525116.6244.847.655.385
DePaul University Fatigue Questionnaire : Trouble expressing thoughts2.0480.07912709.9150.55655.391
Autism: More Decrease in Speaking1.9560.08911878.7849.852.455.441
DePaul University Fatigue Questionnaire : Tense muscles1.8840.06521790.0345.646.955.581
DePaul University Fatigue Questionnaire : Post-exertional malaise, feeling worse after doing activities that require either physical or mental exertion2.0440.06413295.6550.949.355.5191
Condition: Non-alcoholic Fatty Liver Disease1.9270.07112291.7648.44955.729
DePaul University Fatigue Questionnaire : Rash2.1410.0712809.34564955.941
Condition: Post-Traumatic Stress Disorder2.0730.0661317252.151.456.161
Autism: More Avoidance of Eye Contact or Poor Eye Contact1.9540.08714132.0849.952.456.226
Condition: ME/CFS with IBS1.9410.06421176.4347.646.656.2146
DePaul University Fatigue Questionnaire : Absent-mindedness2.0060.0719498.3149.65256.2119
Autism: More Behavioral Disturbances2.3810.10513815.9166.763.956.323
Condition: ME/CFS without IBS1.9840.06212510.5849.145.956.489
Physical: Paleo Diet1.7680.03812820.7440.531.556.523
DePaul University Fatigue Questionnaire : Slowness of thought1.9410.0712898.6346.849.456.6104
DePaul University Fatigue Questionnaire : Abnormal sensitivity to light2.0140.0691415448.949.356.7102
Official Diagnosis: Gastroesophageal reflux disease (GERD)2.0150.05719077.851.744.856.765
Autism: More Sleep Disturbances2.1360.08413719.1456.255.956.836
Physical: Good Air Quality1.7150.05512224.2137.642.956.829
DePaul University Fatigue Questionnaire : Need to have to focus on one thing at a time1.9490.06113809.3948.245.656.8120
Physical: Steps Per Day 4000-80001.9130.06612897.5845.547.15760
Autism: More Repetitive Movements2.0380.10512658.4853.662.35729
DePaul University Fatigue Questionnaire : Ringing in the Ears1.9980.06220337.648.447.557.2126
DePaul University Fatigue Questionnaire : Dizziness1.9830.06614162.5746.548.557.365
DePaul University Fatigue Questionnaire : Chemical sensitivity2.2210.06614833.7257.148.557.379
DePaul University Fatigue Questionnaire : Anxiety/tension2.0370.06718111.3151.449.257.5159
Autism: More Intense Focus on One Topic2.3550.05915148.7763.747.757.522
Physical: Tonsils removed2.0770.06913512.9254.645.457.749
General: Anhedonia (inability to feel pleasure)1.9830.06916245.0747.554.157.827
DePaul University Fatigue Questionnaire : Poor hand to eye coodination2.3290.0714096.3857.252.15821
Condition: Psoriasis2.1740.0826532.5256.854.458.233
Neuroendocrine Manifestations: Poor gut motility1.8880.06719063.3144.148.458.3133
DePaul University Fatigue Questionnaire : Concern with driving2.0840.05313892.6553.343.158.340
DePaul University Fatigue Questionnaire : Easily irritated2.0770.0715797.3552.651.358.4142
Physical: Work-Sitting1.9240.06218699.6446.145.258.5139
Physical: Breastfed2.170.04916236.9354.141.158.873
Neurocognitive: Aphantasia ( inability to visualize mental images)1.9390.07814582.4647.757.458.826
Official Diagnosis: Hypercholesterolemia (High Cholesterol)2.0340.06313217.8850.94859.240
Condition: Non-Celiac Gluten Sensitivity2.0190.05713551.5450.244.859.478
DePaul University Fatigue Questionnaire : Slow to react2.1130.0714951.9352.751.259.475
Condition: Asthma2.2020.07114193.3156.955.259.532
Physical: Steps Per Day 8000-160002.180.06319185.9555.547.860.137
Immune Manifestations: Chronic Flatus / Flatulence / gas2.0580.0712241352.449.460.298
Physical: Amalgam fillings2.1080.05529287.5954.239.960.449
Condition: Generalized anxiety disorder2.1830.0773906157.554.760.545
Physical: Appendix removed2.1590.05219123.7155.64260.828
Physical: Pets2.1220.06824978.4653.645.760.890
DePaul University Fatigue Questionnaire : Does physical activity make you feel better1.9090.0720720.1647.451.961.338
Autism: High Functioning2.3830.06115824.1466.946.561.342
Physical: Steps Per Day < 20001.9980.05616104.5249.742.561.563
Comorbid: Panic Attacks2.1940.07332169.335750.362.348
Official Diagnosis: COVID19 (Fully Recovered)2.090.05815757.6752.447.162.427
Condition: Osteoarthritis1.8920.05714280.8748.64463.123
Physical: Organic Diet2.1310.07126542.3153.64663.565
Immune Manifestations: Hyperphagia (abnormally hunger or desire to eat)2.010.05114582.6749.943.563.721

Objective evidence — the smart watch dimension

People who have read my blogs over the last few decades know that I keep to direct evidence; I avoid speculation and “I figure things work this way” thinking. Microbiome tests is a key part of it. My preference is to get as much data as is affordable/reasonable. This is typically my Bacteria Reported/Cost ratio. At the moment, Thorne is the distinctive winner.

Another data source can be smart watches. I have written about this in the past, Monitoring watch for CFS and other Conditions [2021]. After two years, my watch suffered failure on the charging toggle; so time to get a new one — what I got is described below. Every year features increases on smart watches. My first watch took only a few measurements and only on the hour.

Not Prestige Watches

I could go Apple Watch ($400), Fitbit ($300), Samsung ($450) etc. and drop a few hundred dollars for a device that will likely be technologically obsolete in 2 years. Or go with a Chinese model that costs $40 and which will last 2 years or more. In many cases, the key sensors may be the same as used in the prestige models. In some cases, these Chinese watches have features not available on the prestige watches.

Accuracy/Medical Grade is NOT the purpose

I use the watch to detect differences. In general, I find the results are reasonably accurate when I compare to standalone devices.

For most people (especially those with brain fog), their memory is poor and often they do not feel there was any change based on subjective memory. Having daily history going back months allows you to get objective measurements of things that change. Hopefully, it will stop you from ceasing something that is actually helping. Remember, I am very objective evidence based.

Review of my latest watch

You can find them on Temu or Banggoods. My model is E500. Once I got mine, my wife wanted to upgrade to the same model and did.

The screens

How many steps today and hours of sleep with details below

Then Heart Rate, BP and ECG (manually done)

Some Drill Down Details

Sleep Quality is often influenced by the Microbiome

Having daily detail breakdown is sweet!

The heart rate also maps activities (such as steps) providing better understanding!

With a good summary

Blood Pressure is every 5 minutes. With the other data, if there is a spike, you have enough other measurement to evaluate the events and causes.

Oxygen Measurement is far better than a finger device!

And more details

HRV – Heart Rate Variability

With simple summary and ratings

Below is an example from a day that I was pushing myself for physical activity more than usual (some who use the term “out of shape”). Fatigue was definitely happening!

Night Sweats

At present, I do have night sweats — the temperature monitor definitely show it. They start about 3 hours after going to bed and stops when I wake. As is common for people with ME/CFS (including those that are recovered), I have below normal temperatures.

Blood Glucose Levels

This can be very good to determine how well your meals are handled by your body

Bottom Line — Concrete, Detailed Objective Data!

There is a little overhead. I usually do periodic screen captures on my phone and off load the images to my PC so I can compare what was to what is.